PROJECT SUMMARY/ABSTRACT Alcohol use adversely impacts health and can be reduced with evidence-based interventions. Minority populations vulnerable to disparities in health conditions and access to health care, such as transgender individuals, may be more likely to consume alcohol at unhealthy levels and less likely to receive evidence- based care for unhealthy alcohol use due to unique stressors at the individual- system- and community-level. However, little is known regarding patterns of alcohol use among transgender adults and whether unhealthy alcohol use is appropriately addressed in clinical settings among transgender persons is unknown. The proposed 2-year study will be conducted in a unique large national dataset from the Veterans Health Administration (VA)?the largest integrated care system in the U.S. in which patients are routinely screened for unhealthy alcohol use. The dataset offers a unique and important opportunity to identify a large sample of transgender patients and includes measures of alcohol use and evidence-based interventions for unhealthy alcohol use for outpatients who receive care in the nationwide VA over 8 years. Specifically, among a national cohort of patients receiving care in the VA 2009- 2017, we will: 1) Describe alcohol use patterns among transgender adults, overall and relative to non-transgender, and 2) Among patients screening positive for unhealthy alcohol use, describe and compare receipt of evidence-based alcohol-related care (receipt of brief intervention, initiation of and engagement with specialty addictions treatment, and receipt of pharmacotherapy for alcohol use disorders) by transgender status. Secondarily, we will assess mediation and moderation of associations by individual-, system- and community-level stressors. Transgender persons are a vulnerable and stigmatized population who are at risk for health and healthcare disparities. The proposed innovative study will be the first to our knowledge to describe patterns of alcohol use and receipt of alcohol-related care in an adequately sized sample of transgender adults. Findings will lay the foundation for future intervention research aimed at reducing alcohol and its related risks in this vulnerable population and will pioneer transgender health research processes related to alcohol use that will be scalable to other healthcare systems.